Delirium Treatment & Management

Updated: Aug 23, 2017
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MHA, MPH; Chief Editor: Randon S Welton, MD  more...
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Treatment

Medical Care

When delirium is diagnosed or suspected, the underlying causes should be sought and treated. Despite every effort, no cause for delirium can be found in a small percentage of patients. Components of delirium management include supportive therapy and pharmacological management.

Fluid and nutrition should be given carefully because the patient may be unwilling or physically unable to maintain a balanced intake. For the patient suspected of having alcohol toxicity or alcohol withdrawal, therapy should include multivitamins, especially thiamine.

Reorientation techniques or memory cues such as a calendar, clocks, and family photos may be helpful. The environment should be stable, quiet, and well-lighted. One study showed a reduction of sound during the night by using earplugs in the ICU setting decreased the risk of delirium by 53%, and improved the self-reported sleep perception of the patient for 48 hours. [34] Sensory deficits should be corrected, if necessary, with eyeglasses and hearing aids. Family members and staff should explain proceedings at every opportunity, reinforce orientation, and reassure the patient. Support from a familiar nurse and family should be encouraged. A meta-analysis of 7 studies that focused on the usefulness of interventions such as physical or occupational therapy, daily reorientation, and the avoidance of sensorial deprivation found a significant reduction in the development of delirium among elderly inpatients. [35]

Physical restraints should be avoided. Delirious patients may pull out intravenous lines, climb out of bed, and may not be compliant. Perceptual problems lead to agitation, fear, combative behavior, and wandering. Severely delirious patients benefit from constant observation (sitters), which may be cost effective for these patients and help avoid the use of physical restraints. These patients should never be left alone or unattended.

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Consultations

Psychiatric consultation may be indicated for management of behavioral problems such as agitation or aggressive behavior.

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